Aerobic, resistance and combined exercise training for patients with amyotrophic lateral sclerosis: a systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to assess the effect of aerobic, resistance and combined exercise training in patients with ALS.A comprehensive systematic search of CENTRAL, CINAHL, SPORTDiscuss, Embase, Scopus, ProQuest was performed from inception to February 2021.The systematic review included all studies that examined the effect of exercise training in ALS patients. Meta-analysis was also carried out on randomized controlled trials (RCTs).Data related to primary outcomes (functional ability, respiratory function, fatigue, pain, quality of life, upper-body strength, lower-body strength and Vo2peak) and secondary outcomes (adverse events and feasibility of exercises) was extracted from all studies and systematically reviewed.16 trials including 532 patients met the inclusion criteria; of these, eight studies were included in this meta-analysis. The meta-analysis found a statistically significant difference in favor of exercise in functional ability (P=0.001), overall quality of life (P=0.03) and Vo2peak (P=0.01). The included trials were generally of poor quality and had a risk of bias. However, the results of sensitivity analysis, after omitting studies with high risk of bias, showed no statistically significant difference in functional ability (P=0.05), overall quality of life (P=0.12) and Vo2peak (P=0.13). Finally, no significant difference was found in respiratory function, fatigue, pain, and upper-body and lower-body strength.The safety and effectiveness of exercise therapy in ALS patients remains unclear and further high quality RCTs with larger sample size are needed. Systematic Review Registration Number PROSPERO CRD42019140011.